Intranasal vasopressin (DDAVP) and intra-dialysis hypotension incidence in end-stage renal disease

Introduction: intradialytic hypotension (IDH) remains one of the most common and potentially lethal acute complications encountered by patients under hemodialysis. To determine the effect of intranasal DDAVP (vasopressin) on IDH incidence and the volume of normal saline required to manage hypotension in hypotension-prone patients with chronic kidney disease stage 5 receiving hemodialysis treatment (CKD 5D). Material and Methods: ten hypotension-prone CKD 5D patients were included in the study. They had experienced IDH for at least 30% of hemodialysis treatments in the preceding month. For 30 days, they received a placebo intranasal spray. For the next month, they received 2 puffs (each containing 10 μg) of vasopressin (DDAVP) 30 minutes before hemodialysis. IDH was defined as a symptomatic decrease in systolic blood pressure (BP) by more than 20 mmHg or a drop in mean arterial pressure (MAP) by more than 10 mmHg. Results: IDH was observed in 68 hemodialysis sessions in the placebo group (63.6%) and 53 sessions in the vasopressin group (49.5%) with a marginally significant difference (P =0.07). A significant difference (P =0.04) was found between the two groups regarding the decrease in systolic BP that was more pronounced in the placebo group. Mean (±SD) normal saline volume administered intravenously was significantly lower in the vasopressin group (34±67.6 mL) compared to the placebo group (77.1±89.8 mL); P<0.001. Hypertonic saline was not required in either group. Conclusion: Although no statistically significant difference was observed between the placebo and intranasal vasopressin groups in terms of IDH incidence, mean systolic BP and MAP measurements were significantly higher in the vasopressin group. Also, the vasopressin group required significantly lower volumes of intravenous normal saline to manage IDH. Although we suggest intranasal vasopressin as a possible pharmacologic treatment to prevent IDH, it must be considered that the low sample size and non-significant difference in IDH frequency made our results non-generalizable. Further studies with a larger number of observations are required to make this statement convincing.

гемодиализ, гипотония, вазопрессин, интраназальный, Hemodialysis, hypotension, vasopressin, intranasal

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